Individual
MRS. CHARRYSE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPC, NCC
Contact information
Practice address
5970 FAIRVIEW RD STE 420, CHARLOTTE, NC 28210-3167
(980) 236-1511
(704) 919-5460
Mailing address
5970 FAIRVIEW RD STE 420, CHARLOTTE, NC 28210-3167
(980) 701-4192
(980) 701-4194
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
11709
NC
101YM0800X
Mental Health Counselor
11709
NC
101YP2500X
Professional Counselor
Primary
11709
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11709
LICENSE NUMBER
NC
Enumeration date
09/14/2015
Last updated
12/27/2019
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